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Undernourished child in Zimbabwe

Zimbabwe springs to Dr Sam Everington's mind when he considers the plight of his East End patients.

It is the malnutrition the 52-year-old GP witnesses at his surgery in Bromley by Bow that recalls his time in the failing African state. "A lot of children are underweight because of poor nutrition," he explains.

"They are undernourished and failing to thrive so they sit in lessons unable to concentrate which affects their education. The closest I've come to this is working in Zimbabwe during the Eighties.

"There was widespread malnutrition and you see the same extremes here: children with bloated stomachs or resembling wizened old men.

"Parents say my kids won't eat anything' but they're surviving on crisps. It's about helping the parents to understand what healthy food is. All children should be taught how to cook."

His patients may live within sight of Canary Wharf, but they are blighted by the 19th century's "dread disease" of tuberculosis. Dr Everington sees a TB case every three months and automatically checks anyone with a suspicious cough. He says: "When I trained at medical school I never expected to see TB in the UK. Now anyone with a persistent cough, you have to consider the possibility of TB."

Vitamin D deficiency is also rampant — the result of the "indoor" lifestyles of families on income support. Child obesity is high because of poor diet, and some four-year-olds are dangerously fat.

"I see children with poor growth and weak teeth because of a lack of vitamin D. I'm always handing out tablets to them," he says.

He is a founding partner of the health section of a community centre in Tower Hamlets, which opened in 1997. At least half his 17,000 patients are living in poverty. A third have mental health problems triggered partly by poor living conditions. At least half the children in the area suffer such symptoms as sleep deprivation, low energy and muscle aches.

Mile End Road is known as "chicken shop mile" because of the cheap takeaways which Dr Everington says are partly to blame for poor nutrition among his patients. Nearly a quarter of 10 to 11-year-olds in the borough are obese.

A study by Queen Mary University revealed the local population has a higher than average incidence of coronary heart disease, stomach and bowel cancer, asthma and other respiratory problems. Infant mortality is 50 per cent higher than the national average. The chance of dying from lung and cervical cancer is also above normal rates.

Dental care is also worsening in the under-fives. Dr Everington, who has worked in the area for 20 years, says: "It's utterly shocking — we see children with their teeth pulled out by the time they are seven. Fluoridation is the only way forward."

Unemployment, which is almost three times the national average, is the biggest cause of health problems. Dr Everington remembers telling one man "I think you need a social worker" to be met with the reply "No. I need a social worker's wage". He adds: "There have been health improvements but there are still massive problems. The quality of housing has improved but sometimes that creates an artificial sense that living standards have improved."

Twenty miles away at the Wimbledon Village Surgery, nearly all the 11,000 patients of Dr Paul Cundy are in the top social bracket.

His concerns relate to long life: dementia is a growing problem. Some complain of conditions associated with an executive lifestyle. "A lot of people come to me with stress. They're maxed out. They've always been a succeeder and reached the top of their tree," says Dr Cundy, 53.

Overall, Dr Cundy believes the health of Londoners has improved. "The NHS is better than it was 10 to 15 years ago. Waiting times are down, people are seen much earlier and a major difference is consistency of care is far better."